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Friday, June 15, 2012

Demand & A Promise

Yes, it’s just like that…except not
quite.

The goal of rapport building and
pairing during ABA therapy is to develop a trusting, close relationship with
the child so they are compliant and find you reinforcing. Not the toy
you have or the bubble machine you just turned on, but you. This goal
isn’t always easy to accomplish and there will be times when even after you
accomplish this goal you have to start over again. Like after the child has
been on vacation and hasn’t seen you in a month, or if the child is feeling ill
or on medication.

A great technique for getting a child
to comply during a therapy session is called “Demand and a Promise”. This
technique can be used in the home or out in public, and it’s very easy to learn.
I’ll also include another bonus tip at the end of this post for getting a child
to comply.

Quick
Note: This technique is more helpful for a child who is overall compliant but
may be having a bad day, going through a regression of behavior, or your pairing
relationship may have weakened recently. If you are working with a client who
is very defiant and noncompliant on a regular basis, I wouldn’t recommend using
this technique. Instead I’d recommend you use 3 Step Prompting for
noncompliant children, and use Demand and a Promise for noncompliant
situations. Make sense? Great.

The idea behind this technique is very
simple: When you present a demand to the child you are “promising” them a
reward in advance, for their compliance.

The demand and a promise technique makes your demand
more exciting and interesting because of the promise attached to it. I typically
use this technique to get a crying, overstimulated, frustrated, or tired child to the therapy
table.

(You don't need to use an index card, that's just for illustrative purposes)

Here’s what the technique looks like:

Procedure:

1. Approach the child as he or she is
engaged in a preferred activity, such as on break. Present a simple demand
to do something else, like “Come sit down”. Make sure that you are within 1-2 feet
of the child when you place the demand as you will be providing
prompts/guidance if necessary.

2. As you deliver the demand show the
child an open palm holding a highly preferred reinforcer.

3. If the child begins to comply with
the demand and does not engage in problem behaviors give them the reinforcer. If
the child does not begin to comply or begins engaging in problem behaviors,
close your hand around the reinforcer and use prompting to finish out the
demand.

Notice the wording “begins to comply”.
With this technique you provide reinforcement before the full demand is
actually completed. If you told the child to come sit down, then once they
stand up and start walking to the therapy table you give them the reinforcer.
If the child says “no”, walks away from you, or ignores the demand, you guide
or physically prompt them to go sit down and they lose the reinforcer.

A very common question I get from
therapists about this technique is “What do I do if the child takes the
reinforcer, and then runs off and goes back to play?” Yes, this may happen.
These kiddos are quite smart.

Once you get the child to the table, do not
immediately apply demands. Praise the child for sitting down (“Nice
sitting down, Tia!”). Turn on music or a DVD and give the child a few
seconds of break while you gather your materials and get your data sheets
together. Over time, this teaches the child that they get something good
for complying, and compliance doesn’t mean immediate work. Doing this
consistently will save you from dealing with a lot of escape behaviors.

Before implementing demand and a promise get in super close proximity so if the child bolts
after taking the reinforcer you are able to immediately block escape and prompt.

**Bonus Tip: Another strategy I use
with kiddos who are sometimes noncompliant is I remove the task from my
demand.

Instead of saying a task statement like “Go clean up the toys”, I say something like
“Come with me” or “Follow me” (again, this wont be as successful with a child who is highly defiant or non
compliant so use 3 step prompting instead). Once the
child follows you to where the toys are instead of saying “Pick those up”, say
“Sit down”. Or you can just sit down yourself and say “Do this”, so the child
will imitate you and sit down. Depending
on how strong the child’s imitation skills are you can start picking up toys
and see if they copy you, or you can present the demand like a question. Such
as “Where does this go?” as you hold up a toy. If needed, prompt the child to
put the toy away. Continue until all the toys have been put away. This
technique is a way to sneak in your demands without making them sound like work. Especially if you are in a session with a crying or whiny child who just wants you to leave them alone, you
definitely don’t want to be giving lots of demands that they probably won’t
do. That just makes your job harder, and who needs that? Saying “Come with me”
doesn’t even sound like a demand, it sounds like a request or invitation.

2
comments:

Very practical tips here, thank you. What is the longest number of sessions you have had to spend on pairing with a learner before being able to place demands beyond mand training? I am starting on a case and the pairing seems to be going slowly, I will certainly continue to try bring other materials that might help, but I wonder what is a normal range of sessions required for adequate pairing in your experience?

"Typical" will always vary greatly, but I would say its usual for my cases that the first several sessions are dedicated to pairing. Depending on how frequently the child is seen, that could translate to a week, or several weeks. While it isn't as common, it also is not unusual that it could take much longer than that. There could be confounding variables, such as issues of separation anxiety from the parents, therapist/staff rushes the process and ruins the rapport, proper reinforcer assessment was not done so the child just isn't interested in the reinforcers, etc.

If you are concerned with the time it is taking to build that rapport/establish instructional control I suggest speaking to the case supervisor about it.